Introduction
The Kenyan Health sector is gradually embracing technology as one of the interventions geared towards achieving Universal Health Coverage (UHC) for all by 2030. One of the components of UHC is the ability of a health system to increase access to health services and track, regulate, and monitor medical cycles such as medicine intake, therapy, and advance specialized treatment in HRH limited areas. The government's support and commitment to improving access to affordable healthcare and reducing out-of-pocket spending lie in the adoption of UHC as a priority for health. In December 2018, Isiolo County was selected as one of the four pilot Counties for UHC with a focus on making health services affordable, accessible, and of the expected quality. Isiolo is also one of the Counties that have adopted telemedicine through a partnership with Kenyatta National Hospital and enabler partners, including Huawei and Safaricom.
Problem Statement/Situation Analysis
Over 70 per cent of the population in Isiolo County lives in rural areas where health facilities are inadequate and sometimes inaccessible. There are three (3) level 4 health facilities (Merti, Isiolo and Garbatulla), four (4) level 3 health facilities and forty-one (41) level 2 health facilities in the County. The County experiences inequitable coverage of health services which results in disparities between Sub-Counties, urban and rural residents, thus poor health statistics and low performance in indicators.
Health human resource in Isiolo County are below the required WHO-recommended ratio of health practitioner to patient. Isiolo County has 1159 health workers and support staff against the recommended minimum of 2338, meaning there is a gap of 1179.
There exists a disparity in numbers, cadres and distribution of the health workforce in the County. For instance, the Garbatulla level 3 health facility has only one doctor. The doctor–population ratio for the County is 1:20,000. The County has a maternal mortality rate of 790/100,000 against the national target of 342/100,000. Skilled birth deliveries are also low with an estimated 50% of women delivering at home.
Isiolo is heavily dependent on referral services for specialized care. Besides the semi-functional County referral system, advancing referral services has been an uphill task for the County due to the poor road infrastructure, long distances travelled to reach the County Referral Hospital and erratic operation and maintenance of ambulatory services.
With the vastness of the County, telemedicine technology enhanced the UHC agenda by opening up remote areas to have access to medical specialists and facilitate reliable and efficient healthcare services. Telemedicine saves time and significantly reduces the indirect cost of care.
Additionally, telemedicine reduces the chances of cross-infection and transmission of infectious diseases from a patient to a healthcare professional. This technology saves time and offers time-efficient solutions.
Implementation of the practice
In May 2022, Isiolo County signed an MoU with Kenyatta National Hospital as a framework for collaboration in implementing joint integrated development programmes on telemedicine. The MoU has three objectives:
1. Increase access and utilization of specialized care for residents of Isiolo County. This required the set-up of a teleconnection between the County Teaching and Referral Hospital and Kenyatta National Hospital; a three-way linkage between the Subcounty facilities, the County facility and the national referral facility. For the pilot phase, the full connection was done in Garbatulla Sub-County Hospital.
Huawei, a technology company which develops high-resolution equipment, partnered with Isiolo County to deliver health care through telemedicine. The tech company procured and installed high-resolution cameras and monitors in four level 4 and 5 health facilities.
2. Capacity building of systems users (health workers and health managers) for effective utility of telemedicine and electronic health management systems. The Health Department in the County schedules weekly medical education for health service providers.
3. Installation, use and interoperability of comprehensive electronic management system in 31 health facilities (L2-L4) and community units (L1) in the County. This will complete the hub and scope model for proper referral of conditions, which aids the treatment and management of complicated cases in facilities that have few staff and far-flanged lower facilities.
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